Interventional Treatment of Traumatic Therapy-refractory Chylascites

Traumatic, post-surgical chylous ascites (CA) arises from lymphatic leakage or flow anomalies (e.g. obstruction). Lymphatic interventions are emerging treatment options of these pathologies {1}. However, data regarding clinical outcome is limited {2}. We therefore intend to describe our experiences with lymphatic interventions for treatment of refractory traumatic CA.

Materials and Methods:

35 patients (25 male; mean age 53.7 years) with refractory traumatic CA (isolated CA n=30; combined CA/chylothorax n=5) underwent oil-based x-ray lymphangiography (LA). Imaging was evaluated regarding: lymphatic leakage, reflux or obstruction with/without leakage.

Transabdominal lymph vessel embolization with coils and/or glue was usually performed if leakage, reflux or obstruction with leakage was detected. Patient received LA alone when obstruction without leakage or normal findings were seen. Therapy was deemed clinically successful when CA resolved or greatly improved so that no further therapy was necessary.

Results:

LA was technically successful in all cases and showed leakage in 13/35 (37.1%), reflux in 2/35 (5.7%), obstruction with/without leakage in 13/35 (37.1%) / 4/35 (11.4%), respectively, and normal findings in 3/35 (8.6%).

Lymphatic embolization was performed in 24/35 (68.6%) and was technically successful in all. After embolization, CA resolved or improved in 19/24 (79.1%) and 4/24 (16.7%), respectively (clinical success rate 95.8%). 11/35 (31.4%) underwent LA alone with resolution or improvement of CA in 7/11 (63.6%) and 1/11 (9.1%), respectively (clinical success rate 72.7%). Overall clinical success was achieved in 31/35 (88.6%). Two minor complications were observed (5.7%): venous glue migration, transitory leg edema (both CTCAE grade 1). No recurrence of CA or other sequelae were recorded during a mean follow-up of 24 (1-52) months.

Conclusion:

Lymphatic interventions are an effective and safe treatment option of refractory traumatic chylous ascites. Especially lymph vessel embolization has a high clinical success rate and should be attempted when feasible.